%0 Journal Article
%T Fully covered self-expanding metal stents in the management of difficult common bile duct stones Pr車tesis met芍licas autoexpandibles totalmente recubiertas en el tratamiento de coledocolitiasis dif赤ciles
%A Jes迆s Garc赤a-Cano
%A Amanda Karolina Reyes-Guevara
%A Teresa Mart赤nez-P谷rez
%A Laura Valiente-Gonz芍lez
%J Revista Espaˋola de Enfermedades Digestivas
%D 2013
%I The Spanish Society of Digestive Pathology
%X Background and objectives: plastic biliary stents are often used after an ERCP session without complete common bile duct stones (CBDS) extraction. Sometimes, the volume of biliary drainage with these stents may be insufficient. We present our experience with the use of fully covered self-expanding metal stents (FCSEMS) in the setting of incomplete CBDS extraction. Patients and methods: after an ERCP session with difficult CBDS not completely removed, biliary FCSEMS (Wallflex) were inserted in some patients when it was deemed that biliary sphincterotomy and a single plastic stent would not provide an adequate drainage. Results: a retrospective study was performed. Biliary FCSEMS were inserted in 29 patients, mean age 81 years. CBDS could not be extracted through a biliary sphincterotomy due to its large size (n = 18) or because of the presence of inflammatory distal strictures (n = 11). The greatest biliary drainage with shortest ERCP time was considered mandatory due to clinical instability of patients and/or poor tolerance to conscious sedation administered by the endoscopist. Successful biliary drainage was obtained in all cases. FCSEMS were removed after a median of 199.5 days in 16 patients with a complete CBDS extraction in 15 (93.7%). FCSEMS were not removed in the remaining 13 patients due to their clinical condition, and a wait-and-see strategy was undertaken. Conclusions: in selected cases, utilization of removable FCSEMS can be a good option for a quick and adequate biliary drainage in the setting of difficult CBDS. Because of the higher cost of these stents its use needs to be individualized. Introducci車n y objetivos: las pr車tesis biliares pl芍sticas suelen emplearse tras una sesi車n de CPRE sin extracci車n completa de coledocolitiasis. En ocasiones, el calibre de drenaje con estas pr車tesis puede ser insuficiente. Presentamos nuestra experiencia en la utilizaci車n de pr車tesis met芍licas autoexpandibles totalmente recubiertas (PMATR) en coledocolitiasis no extra赤das. Pacientes y m谷todos: se insert車 una PMATR (Wallflex biliar) en algunos pacientes con coledocolitiasis dif赤ciles no extra赤das tras una sesi車n de CPRE cuando se consider車 que la esfinterotom赤a biliar y una pr車tesis pl芍stica no aportaban un calibre de drenaje adecuado. Resultados: estudio retrospectivo en el que se utiliz車 una PMATR en 29 pacientes, edad media 81 a os. Las coledocolitiasis no pudieron extraerse por la esfinterotom赤a biliar debido a su gran tama o (n = 18) o por la presencia de estenosis distal inflamatoria (n = 11). Se consider車 que era preciso el mayor drenaje biliar con
%K CPRE
%K Coledocolitiasis dif赤ciles
%K Pr車tesis pl芍sticas biliares
%K Pr車tesis met芍licas autoexpandibles totalmente recubiertas
%K ERCP
%K Difficult common bile duct stones
%K Biliary plastic stents
%K Fully covered self-expanding metal stents
%U http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1130-01082013000100003